Implant retaining loop and guide wire extension

ABSTRACT

A surgical assembly, the assembly including a first guidewire, a second guidewire, in which each of the first guidewire and the second guidewire are configured to be received by a bone block, a first suture loop, a second suture loop, a first locking component, and a second locking component, in which the first locking component is coupled to the first suture loop and the second locking component is coupled to the second suture loop.

CROSS REFERENCE TO RELATED APPLICATION

This patent application is a divisional of U.S. patent application Ser.No. 13/188,254, filed on Jul. 21, 2011, now U.S. Pat. No. 9,320,557, forIMPLANT RETAINING LOOP AND GUIDE WIRE EXTENSION. The above-referencedapplication is herein incorporated by reference in its entirety for allpurposes.

The etiology of anterior-inferior glenohumeral instability ismultifactorial. Avulsion fractures of the anterior glenoid rim,so-called bony Bankart lesions, are associated with anterior-inferiorglenohumeral instability. Successful treatment of this conditionrequires a surgical approach that allows relevant lesions, which maycause shoulder instability, to be identified and repaired.

Presently, anterior-inferior shoulder instability associated withlesions in soft tissue can be successfully treated arthroscopically, andthe clinical outcomes may be generally similar to those found after anopen procedure. However, the major risk of recurrent instability afteran arthroscopic procedure, when compared to an open procedure, isrelated to the presence of additional bony defects of the glenoid. Apresent method of bony Bankart repair, or treating anterior-inferiorglenohumeral instability, involves pushing/pulling a bone block withgraspers within the body and securing the bone block with a suture andscrews. Manipulating the bone block within the body using graspers andsecuring the bone block within the body using sutures may be difficult,and as a result, time-consuming, for a surgeon.

Accordingly, there exists a need for an improved technique for treatinganterior-inferior glenohumeral instability.

SUMMARY OF INVENTION

According to one aspect of the present invention, there is provided asurgical assembly, the assembly including a first guidewire, a secondguidewire, in which each of the first guidewire and the second guidewireare configured to be received by a bone block, a first suture loop, asecond suture loop, a first locking component, and a second lockingcomponent, in which the first locking component is coupled to the firstsuture loop and the second locking component is coupled to the secondsuture loop.

According to another aspect of the present invention, there is provideda surgical method, the method including forming a posterior portal in abody, forming an anterior portal in the body, inserting a firstguidewire and a second guidewire into the posterior portal, pulling eachof the first guidewire and the second guidewire out of the body, throughthe anterior portal, disposing each of the first guidewire and thesecond guidewire through a bone block, securing a first suture loop tothe first guidewire and a second suture loop to the second guidewire,disposing the bone block into the body with the first guidewire and thesecond guidewire, through the anterior portal, removing each of thefirst suture loop and the second suture loop, and securing the boneblock within the body, against the glenoid.

According to another aspect of the present invention, there is provideda surgical kit, the kit including a first cannula having a hole formedtherethrough and configured to receive a bone block, a proximal end, adistal end, and a central axis defined therethrough, a first guidewire,a second guidewire, a first suture loop comprising a first lockingmember, and a second suture loop comprising a second locking member.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 shows a perspective view of a surgical assembly according toembodiments disclosed herein.

FIGS. 2A-2F show multiple views of a surgical assembly according toembodiment disclosed herein.

FIGS. 3A-3R show a method of using a surgical assembly within a bodyaccording to embodiments disclosed herein.

DETAILED DESCRIPTION

The following is directed to various exemplary embodiments of thedisclosure. Although one or more of these embodiments may be preferred,the embodiments disclosed should not be interpreted, or otherwise used,as limiting the scope of the disclosure, including the claims. Inaddition, those having ordinary skill in the art will appreciate thatthe following description has broad application, and the discussion ofany embodiment is meant only to be exemplary of that embodiment, and notintended to suggest that the scope of the disclosure, including theclaims, is limited to that embodiment.

Certain terms are used throughout the following description and claimsrefer to particular features or components. As those having ordinaryskill in the art will appreciate, different persons may refer to thesame feature or component by different names. This document does notintend to distinguish between components or features that differ in namebut not function. The figures are not necessarily to scale. Certainfeatures and components herein may be shown exaggerated in scale or insomewhat schematic form and some details of conventional elements maynot be shown in interest of clarity and conciseness.

In the following discussion and in the claims, the terms “including” and“comprising” are used in an open-ended fashion, and thus should beinterpreted to mean “including, but not limited to . . . .” Also, theterm “couple” or “couples” is intended to mean either an indirect ordirect connection. Thus, if a first component is coupled to a secondcomponent, that connection may be through a direct connection, orthrough an indirect connection via other components, devices, andconnections. Further, the terms “axial” and “axially” generally meanalong or substantially parallel to a central or longitudinal axis, whilethe terms “radial” and “radially” generally mean perpendicular to acentral, longitudinal axis.

Additionally, directional terms, such as “above,” “below,” “upper,”“lower,” etc., are used for convenience in referring to the accompanyingdrawings. In general, “above,” “upper,” “upward,” and similar termsrefer to a direction toward the earth's surface from below the surfacealong a borehole, and “below,” “lower,” “downward,” and similar termsrefer to a direction away from the surface along the borehole, i.e.,into the borehole, but is meant for illustrative purposes only, and theterms are not meant to limit the disclosure.

Referring now to FIG. 1, a perspective view of a surgical assembly 100,in accordance with embodiments disclosed herein, is shown. In one ormore embodiments, the assembly 100 may include a first cannula 101, afirst guidewire 111, a second guidewire 112, a first suture loop 121, asecond suture loop 122, a first locking member 123, and a second lockingmember 124. As shown, each of the first guidewire 111 and the secondguidewire 112 are configured to be received by a bone block 110.Further, as shown, the first locking component 123 is coupled to thefirst suture loop 121 and the second locking component 124 is coupled tothe second suture loop 122.

In one or more embodiments, the first cannula 101 may include a hole 109formed therethrough, a proximal end 105, a distal end (not shown), and acentral axis 150 defined therethrough. In one or more embodiments, thehole 109 of the first cannula 101 may be configured to receive a boneblock/graft, e.g., the bone block 110. As will be discussed below, inone or more embodiments, the first guidewire 111 and the secondguidewire 112 may be used to reposition, or reorient, the bone block 110such that the bone block 110 may be disposed within the hole 109 of thefirst cannula 101 and displaced through the first cannula 101. Forexample, in one or more embodiments, the bone block 110 may berepositioned, or reoriented, by the first guidewire 111 and the secondguidewire 112 such that a longitudinal axis of the bone block 110 issubstantially parallel with the central axis 150 of the first cannula101. Further, the first guidewire 111 and the second guidewire 112 maybe used to move, or displace, the bone block 110 through the firstcannula 101, into a body (not shown).

In one or more embodiments, each of the first guidewire 111 and thesecond guidewire 112 may be formed from any substantially rigid materialor any flexible material known in the art. For example, each of thefirst guidewire 111 and the second guidewire 112 may be made of aplastic or a metal, such as Nitinol. Further, in one or moreembodiments, each of the first guidewire 111 and the second guidewire112 may be looped guidewires. In other words, in one or moreembodiments, the first guidewire 111 may include a first loop 117 andthe second guidewire 112 may include a second loop 118. In one or moreembodiments, the first loop 117 of the first guidewire 111 and thesecond loop 118 of the second guidewire 112 may be configured to receivesuture loops 121, 122, respectively. Although FIG. 1 shows an embodimentof the surgical assembly 100 with only two guidewires 111, 112, thosehaving ordinary skill in the art will appreciate that more or less thantwo guidewires may be used. For example, in one or more embodiments,one, three, four, or more guidewires may be used.

In one or more embodiments, the first suture loop 121 may be configuredto be secured to the first guidewire 111 and the second suture loop 122may be configured to be secured to the second guide wire 112. Forexample, as shown, the first suture loop 121 is configured to be securedto the first loop 117 of the first guidewire 111 and the second sutureloop 122 is configured to be secured to the second loop 118 of thesecond guidewire 112. As will be discussed below, in one or moreembodiments, the first suture loop 121 may be displaced, looped orpassed, through the first loop 117 of the first guidewire 111, and alsodisplaced, looped or passed, back through itself in order to secure thefirst suture loop 121 and the first locking member 123 to the first loop117 of the first guidewire 111. Similarly, the second suture loop 122may be displaced, looped or passed, through the second loop 118 of thesecond guidewire 112, and also displaced, looped or passed, back throughitself in order to secure the second suture loop 122 and the secondlocking member 124 to the second loop 118 of the second guidewire 112.In one or more embodiments, in order to remove, or disengage, each ofthe first suture loop 121 and the second suture loop 122 from the firstguidewire 111 and the second guidewire 112, respectively, a surgeon maypull each of the first locking member 123 and the second locking member124 in a direction that is substantially away from each of theguidewires 111, 112. Pulling each of the first locking member 123 andthe second locking member 124 in a direction that is substantially awayfrom each of the guidewires 111, 112 may cause each of the suture loops121, 122 to become unraveled, or become un-looped, and disengaged fromeach of the guidewires 111, 112.

Further, in one or more embodiments, each of the first suture loop 121and the second suture loop 122 may be formed from any flexible materialknown in the art, such as suture, plastic, or a malleable metal, such asNitinol. In one or more embodiments, each of the first suture loop 121and the second suture loop 122 may be a closed, continuous loop.Alternatively, in one or more embodiments, each of the first suture loop121 and the second suture loop 122 may be closed and may contain a knot(not shown).

As discussed above, in one or more embodiments, the first lockingcomponent 123 may be coupled to the first suture loop 121 and the secondlocking component 124 may be coupled to the second suture loop 122.Those having ordinary skill in the art will appreciate that the firstlocking component 123 and the second locking component 124 may becoupled to the first suture loop 121 and the second suture loop 122,respectively, by any means known in the art. For example, the firstlocking component 123 and the second locking component 124 may becoupled to the first suture loop 121 and the second suture loop 122,respectively, by mechanical or chemical means, such as crimping,molding, or gluing. Alternatively, in one or more embodiments, each ofthe first locking component 123 and the second locking component 124 mayinclude a hole formed therethrough, in which each of the first lockingcomponent 123 and the second locking component 124 may be threaded ontothe first suture loop 121 and the second suture loop 122, respectively,e.g., a bead on a necklace. As shown, each of the first lockingcomponent 123 and the second locking component 124 is substantiallyspherical in shape. Those having ordinary skill in the art willappreciate that the shape of the first locking component 123 and thesecond locking component 124 may be any shape known in the art. Forexample, the shape of each of the first locking component 123 and thesecond locking component 124 may be spherical, hemi-spherical, cubic,prismatic, pyramidal, or any other shape known in the art. Further, eachof the first locking component 123 and the second locking component 124may be formed from any material known in the art. For example, in one ormore embodiments, each of the first locking component 123 and the secondlocking component 124 may be formed from metal, plastic, ceramic, or anyother material known in the art. Alternatively, each of the firstlocking component 123 and the second locking component 124 may be formedform any biocompatible material known in the art.

Referring to FIGS. 2A-2F, multiple views of a surgical assembly 200, inaccordance with embodiments disclosed herein, are shown. In one or moreembodiments, the assembly 200 may include a first cannula 201, a firstguidewire 211, a second guidewire 212, a first suture loop 221, a secondsuture loop 222, a first locking member 223, and a second locking member224.

As shown in FIG. 2A, the first cannula 201 includes a hole 209 formedtherethrough, a proximal end 205, a distal end (not shown), and acentral axis 250 defined therethrough is shown. In one or moreembodiments, each of the first guidewire 211 and the second guidewire212 may be disposed within, or inserted into, the first cannula 201through an end of the first cannula, e.g., the distal end, and displacedthrough the first cannula 201, and may exit through the proximal end 205of the first cannula 201. As discussed above, each of the firstguidewire 211 and the second guidewire 212 may be formed from anysubstantially rigid material or any flexible material known in the art.For example, each of the first guidewire 211 and the second guidewire212 may be made of a plastic or a metal, such as Nitinol. Further, inone or more embodiments, each of the first guidewire 211 and the secondguidewire 212 may be looped guidewires. In other words, as shown, thefirst guidewire 211 may include a first loop 217 and the secondguidewire 212 may include a second loop 218.

As shown in FIG. 2B, the first guidewire 211 may be disposed through thefirst cannula 201 and through a bone block 210. As shown, the bone block210 includes two holes 219A, 219B, which are configured to receive thefirst guidewire 211 and the second guidewire 212, respectively. Thosehaving ordinary skill in the art will appreciate that the bone block 210may be any bone block or bone graft that may be used in a surgicalprocedure. For example, in one or more embodiments, the bone block 210may be used to treat anterior inferior glenohumeral instability within abody. Alternatively, the bone block 210 may be a bone block or bonegraft of an appropriate size and shape, e.g. of appropriate dimensions,that may be used in a surgical procedure involving the hip, knee, wrist,or ankle in a body.

As shown in FIG. 2C, once the first guidewire 211 has been disposedthrough the bone block 210, the first suture loop 221 may be displaced,looped or passed, through the first loop 217 of the first guidewire 211.Further, as shown, the first locking component 223 is coupled to thefirst suture loop 221. As discussed above, in one or more embodiments,the first locking component 223 may be coupled to the first suture loop221. Those having ordinary skill in the art will appreciate that thefirst locking component 223 may be coupled to the first suture loop 221,by any means known in the art. For example, the first locking component223 may be coupled to the first suture loop by mechanical or chemicalmeans, such as crimping, molding, or gluing. Alternatively, in one ormore embodiments, the first locking component 223 may include a holeformed therethrough, in which the first locking component 223 may bethreaded onto the first suture loop 221, e.g., a bead on a necklace.

As shown in FIG. 2D, the first suture loop 221 may be also displaced,looped or passed, back through itself, e.g., in the direction of arrowP, in order to secure the first suture loop 221 and the first lockingmember 223 to the first loop 217 of the first guidewire 211. Asdiscussed above, in one or more embodiments, the first suture loop 221may be formed from any flexible material known in the art, such assuture, plastic, or a malleable metal, such as Nitinol. In one or moreembodiments, the first suture loop 221 may be a closed, continuous loop.Alternatively, in one or more embodiments, the first suture loop 221 maybe closed and may contain a knot (not shown).

As shown in FIG. 2E, once the first suture loop 221 is displaced, loopedor passed, through the first loop 217 of the first guidewire 211 andalso displaced, looped or passed, back through itself, the first sutureloop 221 may be tensioned, e.g., substantially in the direction of thearrow P of FIG. 2D, to secure the first suture loop 221 and the firstlocking member 223 to the first guidewire 211. Those having ordinaryskill in the art will appreciate that the first suture loop 221 may besecured to the first guidewire 211 by other methods known in the art,other than what is described above. For example, the first suture loop221 may be tied in a knot to the first guidewire 211. Alternatively, thefirst suture loop 221 may be displaced, looped or passed, through thefirst loop 217 of the first guidewire 211, and an end of the firstsuture loop 221 may be wrapped, or twisted, around an opposite end ofthe first suture loop 221 in order to secure the first suture loop 221to the first guidewire 211. Further, as discussed above, in one or moreembodiments, in order to remove, or disengage, the first suture loop 221from the first guidewire 211, a surgeon may pull the first lockingmember 223 in a direction that is substantially away from the firstguidewire 211. Pulling the first locking member 223 in a direction thatis substantially away from the first guidewire 211 may cause the firstsuture loop 221 to become unraveled, or become un-looped, and disengagedfrom the first guidewire 211.

Referring now to FIG. 2F, a perspective view of the assembly 200, inaccordance with embodiments disclosed herein, is shown. As shown, thesame procedure, shown and described above in FIGS. 2B-2E with regard tothe first guidewire 211 and the first suture loop 221, may be applied tothe second guidewire 212 and the second suture loop 222. For example, inone or more embodiments, the second guidewire 212 may be disposedthrough the hole 219B of the bone block 210. Further, in one or moreembodiments, the second suture loop 222 may be displaced, looped orpassed, through the second loop 218 of the second guidewire 212.Furthermore, in one or more embodiments, the second suture loop 222 maybe also displaced, looped or passed, back through itself, e.g., in thedirection of the arrow P of FIG. 2D, in order to secure the secondsuture loop 222 and the second locking member 224 to the second loop 218of the second guidewire 212. Moreover, in one or more embodiments, oncethe second suture loop 222 is displaced, looped or passed, through thesecond loop 218 of the second guidewire 212 and also displaced, loopedor passed, back through itself, the second suture loop 222 may betensioned, e.g., substantially in the direction of the arrow P of FIG.2D, to secure the second suture loop 222 and the second locking member224 to the second guidewire 212. As discussed above, the bone block 210may be repositioned, or reoriented, by the first guidewire 211 and thesecond guidewire 212 such that a longitudinal axis of the bone block 210is substantially parallel with the central axis 250 of the firstcannula. Further, the first guidewire 211 and the second guidewire 212may be used to move, or displace, the bone block 210 through the firstcannula 201.

A surgical method, in accordance with embodiments disclosed herein, mayinclude forming a posterior portal in a body, forming an anterior portalin the body, inserting a first guidewire and a second guidewire into theposterior portal, pulling each of the first guidewire and the secondguidewire out of the body, through the anterior portal, disposing eachof the first guidewire and the second guidewire through a bone block,securing a first suture loop to the first guidewire and a second sutureloop to the second guidewire, disposing the bone block into the bodywith the first guidewire and the second guidewire, through the anteriorportal, removing each of the first suture loop and the second sutureloop, and securing the bone block within the body, against the glenoid.

In one or more embodiments, disposing the bone block into the body mayinclude orienting the bone block such that a longitudinal axis of thebone block is substantially parallel to the central axis of the firstcannula. In one or more embodiments, pulling each of the first guidewireand the second guidewire out of the body may include using a grasper topull each of the first guidewire and the second guidewire out of thebody, through the anterior portal. Further, in one or more embodiments,disposing the bone block into the body may include pushing the boneblock into the body, through the first cannula, with an obturator. Inone or more embodiments, disposing the bone block into the body mayinclude pulling the bone block into the body, through the first cannula,with each of the first guidewire and the second guidewire. Furthermore,in one or more embodiments, securing the bone block within the bodycomprises securing at least one threaded screw through the bone block,into the glenoid.

The method may also include disposing a guide comprising a hook into thebody, through the posterior portal, positioning the hook of the guide onan anterior side of the glenoid, forming a first hole and a second holethrough the glenoid, from the posterior side of the glenoid to theanterior side of the glenoid, inserting a first cannula into the body,through the anterior portal, the first cannula comprising a hole formedtherethrough, a proximal end, a distal end, and a central axis definedtherethrough, and removing each of the first guidewire and the secondguidewire from the body.

For example, referring now to FIGS. 3A-3R, a surgical method, inaccordance with embodiments disclosed herein, is shown. In one or moreembodiments, a surgical assembly 300 may include a first cannula 301, afirst guidewire 311, a second guidewire 312, a first suture loop 321, asecond suture loop 322, a first locking member 323, and a second lockingmember 324.

Referring to FIG. 3A, a spinal needle (not shown) may be inserted from aposterior side of a glenoid 340 to an anterior side of the glenoid 340,along a face of the glenoid 340. According to one or more aspects, thespinal needle may be positioned below an equator (not shown) of theglenoid 340 and may be used to confirm placement of a posteriorinstrument portal (not shown). Once the posterior instrument portal isformed, a hooked end 331 of a glenoid guide 330 may be disposed within,or inserted through, the posterior instrument portal. The hooked end 331of the glenoid guide 330 may be passed across the glenoid 340 and overan anterior edge 341 of the glenoid 340, substantially parallel to theglenoid face in order to avoid damaging the articular surface. Theglenoid guide 330 may be rotated such that the hooked end 331 of theglenoid guide 330 may engage the anterior edge 341 of the glenoid 340.The hooked end 331 of the glenoid guide 330 may be placed at the 4o'clock position and may correlate with a midpoint of a bone block (notshown). However, those having ordinary skill in the art will appreciatethat the hooked end 331 of the glenoid guide 330 may be placed at anyposition on the glenoid 340. For example, the hooked end 331 of theglenoid guide 330 may be placed at the 2 o'clock position and maycorrelate with the midpoint of the bone block.

Referring to FIG. 3B, once the hooked end is positioned, a first guide333 may be placed in a superior hole (not shown) of the glenoid guide330. A skin incision may be made and the first guide 333 may be advancedinto the body until the first guide 333 engages a posterior side of theglenoid 340. The first guide 333 may include ratchet teeth 337, orthreads, that may engage with corresponding ratchet threads, or threads,of the glenoid guide 330. According to one or more aspects, the firstguide 333 may be advanced, displaced, and/or secured into the body,along the glenoid guide 330 using the ratchet teeth 337. Similarly, asecond guide 334 may also be disposed into the body and may also engagea posterior side of the glenoid 340. According to one or more aspects,the second guide 334 may be placed in an inferior hole (not shown) ofthe glenoid guide 330. Further, a first sleeve (not shown) and a secondsleeve (not shown) may be disposed within the first guide 333 and thesecond guide 334, respectively, and may be engaged with the posteriorside of the glenoid 340.

Referring to FIGS. 3C and 3D, a first hole 349A and a second hole 349Bmay be formed through the glenoid, from the posterior side of theglenoid 340 to the anterior side 341 of the glenoid 340. According toone or more aspects, a drill (not shown) may be disposed within each ofthe first guide 333 and the second guide 334, shown in FIG. 3B, and maybe advanced under power until the drill bit, e.g., drill bits 344A,344B, exits the anterior edge/side 341 of the glenoid 340. As shown, thehooked end 331 of the glenoid guide (not shown) may provide a force inthe posterior direction, i.e., in the direction of arrow W, while thedrill bits 344A, 344B may be advanced in the anterior direction, i.e.,in a direction that is opposite to the arrow W. According to one or moreaspects, a 2.8 mm drill may be used to form the first hole 349A and thesecond hole 349B. However, those having ordinary skill in the art willappreciate that any size drill may be used to form the first hole 349Aand the second hole 349B. According to one or more aspects, each of thefirst hole 349A and the second hole 349B may be 5 mm on center below acortical edge of the glenoid face, and the holes 349A, 349B formed bythe drill may be parallel to one another, and may be 10 mm apart, centerto center. However, those having ordinary skill in the art willappreciate that each of the holes 349A, 349B may be formed more or less5 mm, and may not necessarily be on center, below a cortical edge of theglenoid face. Further, those having ordinary skill in the art willappreciate that the holes 349A, 349B may be more or less than 10 mmapart, center to center. Furthermore, those having ordinary skill in theart will appreciate that more or less than two holes, e.g., the firsthole 349A and the second hole 349B, may be formed in the glenoid 340.For example, according to one or more aspects, one hole, or three holes,may be formed in glenoid 340, exiting the anterior side 341 of theglenoid 340.

Referring to FIG. 3E, according to one or more aspects, once forming theholes 349A, 349B is complete, the drill (not shown) may be removed fromeach of the guides (not shown), e.g., the guides 333, 334 of FIG. 3B,leaving the a first sleeve 335 and a second sleeve 336 in place withinthe body, engaged with the posterior side of the glenoid 340, and maycorrespond to the holes 349A, 349B formed on the anterior side/edge 341of the glenoid 340. Further, the glenoid guide (not shown) may beremoved. According to one or more aspects, a 1 mm pin may be disposedwithin each of the sleeves 335, 336 to ensure that the sleeves 335, 336are free from debris. Those having ordinary skill in the art willappreciate that a member of any diameter, smaller or larger than 1 mmthat is configured to be received by the sleeves 335, 336 may be used toremove debris from the sleeves 335, 336 and to ensure that each ofsleeves 335, 336 is free from debris.

Referring to FIG. 3F, a first guidewire 311 and a second guidewire (notshown) may be disposed, or inserted, into the posterior portal, throughthe sleeves (not shown), e.g. the first sleeve 335 and the second sleeve336 of FIG. 3E, respectively, and into the body. Further, an anteriorportal (not shown) may be formed, and a first cannula 301 may bedisposed, or inserted, into the body through the anterior portal. Asshown, the first guidewire 311 may be disposed through the first sleeveand through the first hole 349A formed through the anterior side/edge341 of the glenoid 340. Further, as shown, a grasper 360 may disposedinto a proximal end (not shown) of the first cannula 301, may exit thefirst cannula at a distal end 306 of the first cannula 301, and may beused to engage, or retrieve, the first guidewire 311. According to oneor more aspects, the grasper 360 may be used to pull each of the firstguidewire 311 and the second guidewire out of the body, through theanterior portal, through the first cannula 301.

Referring to FIG. 3G, a bone block 310, according to embodimentsdisclosed herein, is shown. As shown, the bone block 310 may include afirst hole 319A and a second hole 319B. As discussed above, each of theholes 319A, 319B may be configured to receive a first guidewire (notshown) and a second guide wire (not shown). Further, as discussed above,those having ordinary skill in the art will appreciate that the boneblock 310 may be any bone block or bone graft that may be used in asurgical procedure. For example, in one or more embodiments, the boneblock 310 may be used to treat anterior inferior glenohumeralinstability within a body. Alternatively, the bone block 310 may be abone block or bone graft of an appropriate size and shape, e.g. ofappropriate dimensions, that may be used in a surgical procedureinvolving the hip, knee, wrist, or ankle in a body. For example,according to one or more aspects, a tri cortical iliac crest bone block,measuring 20 mm×8 mm×8 mm may be harvested and fashioned using a graftpreparation board. Further, according to one or more aspects, the holes319A, 319B may be 2.8 mm in diameter and may be 10 mm apart, center tocenter. A drill may be used to form the holes 319A, 319B by enteringthrough the cortex and exiting the cancellous side of the bone block310. The holes 319A, 319B may be formed to correspond with the sleeves(not shown), e.g., sleeves 335, 336 placed in the glenoid, shown in FIG.3E, and/or may be formed to correspond with the holes 349A, 349B formedin the glenoid 340, also shown in FIG. 3E. As discussed above, thosehaving ordinary skill in the art will appreciate that more or less thantwo guidewires, e.g. guidewires 311, 312, may be used. For example, inone or more embodiments, one, three, four, or more guidewires may beused. Accordingly, those having ordinary skill in the art will alsoappreciate that more or less than two holes, e.g., holes 319A, 319B, maybe formed through the bone block 310. For example, in one or moreembodiments, one, three, four, or more holes may be formed through thebone block 310.

Referring to FIG. 3H, each of the guidewires 311, 312 may be pulledthrough the first cannula 301, exiting a proximal end 305 of the firstcannula 301. Further, each of the guidewires 311, 312 may be disposedthrough each of the holes 319A, 319B of the bone block 310,respectively. According to one or more aspects, each of the guidewires311, 312 may be inserted through the cancellous side of the bone block310 and may exit through the cortical side of the bone block 310.According to one or more aspects, at least a portion of the guidewires311, 312 may remain outside of the body, posteriorly, and may allow asurgeon to manipulate each of the guidewires 311, 312 posteriorly, whileat least a portion of each of the guidewires 311, 312 is disposed withinthe body and/or is outside of the body on the anterior side.

Referring to FIGS. 3I and 3J, a first suture loop 321 having a firstlocking member 323 may be displaced, looped or passed, through the firstloop 317 of the first guidewire 311, and also displaced, looped orpassed, back through itself, in the direction of arrow D, in order tosecure the first suture loop 321 and the first locking member 323 to thefirst loop 317 of the first guidewire 311. Similarly, as shown in FIG.3J, the second suture loop 322 may be displaced, looped or passed,through the second loop 318 of the second guidewire 312, and alsodisplaced, looped or passed, back through itself in order to secure thesecond suture loop 322 and the second locking member 324 to the secondloop 318 of the second guidewire 312. Further, according to one or moreaspects, each of the first suture loop 321 and the second suture loop322 may be tensioned, e.g., in a direction substantially away from thefirst cannula 301, to secure the first suture loop 321 and the firstlocking member 323 to the first guidewire 311 and to secure the secondsuture loop 322 and the second locking member 324 to the secondguidewire 312. As shown, each of the first locking member 323 and thesecond locking member 324 is resting against the bone block 310.

Referring to FIGS. 3K and 3L, multiple views of the surgical assembly300, in accordance with embodiments disclosed herein, are shown. Asshown, the bone block 310 may be disposed within the first cannula 301,through the proximal end 305 of the first cannula, and may be advancedinto the body through the first cannula 301, through the anteriorportal. According to one or more aspects, disposing the bone block 310into the body may include pushing the bone block 310 into the body,through the first cannula 301, with an obturator 365. According to oneor more aspects, disposing the bone block 310 into the body may includepulling the bone block 310 into the body, through the first cannula 301,with each of the first guidewire 311 and the second guidewire 312.According to one or more aspects, the first guidewire 311 and the secondguidewire 312 may be used to reposition, or reorient, the bone block 310such that the bone block 310 may be disposed within the first cannula301 and displaced through the first cannula 301. For example, in one ormore embodiments, the bone block 310 may be repositioned, or reoriented,by the first guidewire 311 and the second guidewire 312 such that alongitudinal axis of the bone block 310 is substantially parallel with acentral axis 350 of the first cannula 301. Once the bone block 310 isfully inserted into the first cannula 301, the guide wires 311, 312exiting the body, e.g. the shoulder, posteriorly may be tensioned toremove any slack in the guide wires 311, 312. According to one or moreaspects, even if an obturator 365 is used to push the bone block 310into the body through the first cannula 301, slight tension may beapplied and/or maintained on the guidewires 311, 312, e.g., from theposterior side of the guidewires 311, 312.

As shown in FIG. 3L, the bone block 310 may exit the distal end 306 ofthe first cannula 301, inside the body, in a region of the body near theanterior edge/side 341 of the glenoid 340. As discussed above, in one ormore embodiments, the obturator (not shown) may be used to push the boneblock 310 into the body, toward the anterior edge/side 341 of theglenoid 340. Additionally, in one or more embodiments, the firstguidewire 311 and the second guidewire 312, disposed through the holes349A, 349B, respectively, may be used to apply and/or maintain slighttension on the bone block 310, as it is pushed into the body with theobturator. Alternatively, in one or more embodiments, the firstguidewire 311 and the second guidewire 312, disposed through the holes349A, 349B, respectively, may be used to pull the bone block 310 intothe body, toward the anterior edge/side 341 of the glenoid 340, withoutthe use of an obturator.

Referring to FIG. 3M, each of the guidewires (not shown), e.g.guidewires 311, 312 shown in FIG. 3L, disposed within sleeves 335, 336,may be pulled, or tensioned, posteriorly, and the bone block 310 mayexit the distal end 306 of the first cannula 301, and may bemanipulated, reoriented or repositioned, until it is placed in anintended position along the anterior neck of the glenoid 340. Accordingto one or more aspects, the cancellous portion of the bone block 310 maybe secured against the glenoid 340, e.g. a neck of the glenoid 340.Further, according to one or more aspects, a grasper (not shown), e.g.,the grasper 360 shown in FIG. 3F, may be used to manipulate, reorient orreposition, the bone block 310 within the body, against the glenoid 340.During the placement of the bone block 310 within the body, slighttension may be maintained on each of the suture loops 321, 322,anteriorly, such that each of the first locking member 323 and thesecond locking member 324 are engaged with the bone block 310, while theguidewires 311, 312 may be pulled, posteriorly, to seat the bone block310 on the glenoid 340.

Referring to FIGS. 3N and 3O, according to one or more aspects, each ofthe first suture loop 321 and the second suture loop 322 may bedisengaged from the guidewires 311, 312, respectively, and may beremoved from the body. As shown, a second cannula 302 may be disposedwithin the body, in addition to the first cannula 301, in the vicinityof the glenoid 340 and the bone block 310. According to one or moreaspects, the first locking member 323 and the first suture loop 321 maybe disengaged from the first guidewire 311 and removed from the bodythrough the second cannula 302. According to one or more aspects, agrasper (not shown), e.g., the grasper 360 shown in FIG. 3F, may bedisposed through the second cannula 302 used to remove the first lockingmember 323 and the first suture loop 321 from the body, while the secondlocking member 324 remains engaged with the bone block 310. As discussedabove, in one or more embodiments, in order to remove, or disengage, thefirst suture loop 321 from the first guidewire 311, a surgeon may pullthe first locking member 323 in a direction that is substantially awayfrom the first guidewire 311. Pulling the first locking member 323 in adirection that is substantially away from the first guidewire 311 maycause the first suture loop 321 to become unraveled, or becomeun-looped, and disengage from the first guidewire 311.

Once the first locking member 323 and the first suture loop 321 areremoved from the body, a needle guide wire 353 may be placed into thebody, e.g., into a proximal end 307 of the second cannula 302 and mayexit a distal end 308 of the second cannula 302, to create asubscapularis portal in-line with the holes of the bone graft 310, e.g.,holes 319A, 319B of the bone graft 310 shown in FIG. 3G. According toone or more aspects, once in the joint, a cannulated obturator (notshown) and a fixation cannula (not shown) may be inserted over theneedle guidewire 353. According to one or more aspects, tension may beapplied, posteriorly, on the second guidewire 312 in order to helpmaintain security of, e.g., engagement of, the bone block 310 againstthe glenoid 340, as the first guidewire 311 is removed, anteriorly,through the second cannula 302.

Referring to FIGS. 3P-3R, the sleeve (not shown), e.g., the sleeve 335aligned with the hole 349A of the glenoid 340 and engaged with theposterior side of the glenoid 340, may be removed to accommodateplacement of a first fixation screw 351. According to one or moreaspects, the first fixation screw 351 may be inserted into the proximalend 307 of the second cannula 302 and may be passed over the needleguidewire 353, through the second cannula 302, and may be driven intothe body by a drill or a screwdriver 334 until the first fixation screw351 is engaged with the bone block 310, and the bone block 310 issecured against the anterior side/edge 341 of the glenoid 340. Once thefirst fixation screw 351 is secured within the bone block 310 within thebody, the needle guidewire 353 may be removed from the body.

Subsequently, according to one or more aspects, the second lockingmember 324 and the second suture loop 322 may be removed from the bodythrough the first cannula 301 in the same fashion described above, withregard to the first locking member 323 and the first suture loop 321.According to one or more aspects, a second fixation screw 352 may beengaged with the bone block 310 such that the bone block 310 is securedagainst the glenoid 340 in the same fashion as described above, withregard to the first fixation screw 351. For example, the sleeve (notshown), e.g., sleeve 336 aligned with the hole 349B of the glenoid 340and engaged with the posterior side of the glenoid 340, may be removedto accommodate placement of the second fixation screw 352. Further, theneedle guidewire 353 may be disposed through the first cannula 302.Furthermore, according to one or more aspects, the second fixation screw352 may be passed over the needle guidewire 353, through the firstcannula 301, and may be driven into the body by a drill or a screwdriver until the second fixation screw 352 is engaged with the boneblock 310, and the bone block 310 is secured against the glenoid.

Those having ordinary skill in the art will appreciate that a manualscrewdriver, a powered drill, or any means of securing a screw into asurface may be used to secure the first fixation screw 351 and thesecond fixation screw 352 through the bone block 310 and into theglenoid 340. Further, according to one or more aspects, each of thefirst fixation screw and the second fixation screw 352 may be 34 mmcannulated screws. However, those having ordinary skill in the art willappreciate that fixations screws of any size that are adapted to be usedwith the bone block 310 may be used. Further, those having ordinaryskill in the art will appreciate that more or less than two guidewires,e.g. guidewires 311, 312, may be used. For example, in one or moreembodiments, one, three, four, or more guidewires may be used.

According to one or more aspects, anchors may be placed away from thetrajectory of the fixation screws 351, 352 along the anterior edge ofthe glenoid 340, between the glenoid 340 and the bone block 310.Further, according to one or more aspects, sutures may be passed througha labrum and capsule and secured over a top, e.g., a cortical surface,of the bone block 310.

A surgical kit, according to embodiments disclosed herein, may include afirst cannula having a hole formed therethrough and configured toreceive a bone block, a proximal end, a distal end, and a central axisdefined therethrough, a first guidewire, a second guidewire, a firstsuture loop comprising a first locking member, and a second suture loopcomprising a second locking member.

The kit may also include a glenoid guide having a hooked end, a secondcannula having a hole formed therethrough, a proximal end, and a distalend, a grasper, an obturator, a needle guidewire, at least one threadedscrew, wherein the at least one threaded screw is cannulated, and adrill configured to secure the at least one threaded screw into a bone.

Advantageously, embodiments disclosed herein may provide a surgicalassembly, method, and kit that may simplify and improve a technique fortreating anterior-inferior glenohumeral instability. As discussed above,pushing/pulling a bone block with graspers within the body and securingthe bone block with a suture may be difficult, and as a result,time-consuming, for a surgeon. The use of at least one threaded screw tosecure a bone block and the use of guide wires, suture loops, andlocking members to manipulate and secure the bone block within the bodymay help a surgeon in treating anterior-inferior glenohumeralinstability more quickly, precisely, and effectively.

While embodiments have been described with respect to a limited numberof embodiments, those skilled in the art, having benefit of thisdisclosure, will appreciate that other embodiments can be devised whichdo not depart from the scope of embodiments disclosed herein.Accordingly, the scope of embodiments disclosed herein should be limitedonly by the attached claims.

What is claimed is:
 1. A surgical kit comprising: a first cannula havinga hole formed therethrough and configured to receive a bone block, aproximal end, a distal end, and a central axis defined therethrough; afirst guidewire; a second guidewire; a first suture loop comprising afirst locking member; a second suture loop comprising a second lockingmember; a glenoid guide having a hooked end; a second cannula having ahole formed therethrough, a proximal end, and a distal end; a grasper;an obturator; and a needle guidewire.
 2. The kit of claim 1, furthercomprising fixation member and a drill configured to secure the at leastone fixation member into a bone.
 3. The kit of claim 1, wherein the atleast one fixation member is configured to engage the bone block.
 4. Thekit of claim 1, wherein at least one of the first guidewire and thesecond guidewire is configured to be received by the bone block.
 5. Thekit of claim 1, wherein at least one of the first guidewire and thesecond guidewire comprise Nitinol.
 6. The kit of claim 1, wherein thefirst guidewire includes a first loop and the second guidewire includesa second loop.
 7. The kit of claim 6, wherein the first loop of thefirst guidewire is configured to receive the first suture loop and thesecond loop of the second guidewire is configured to receive the secondsuture loop.
 8. The kit of claim 6, wherein the first suture loop isconfigured to be secured to the first loop of the first guidewire andthe second suture loop is configured to be secured to the second loop ofthe second guidewire.
 9. The kit of claim 1, wherein at least one of thefirst suture loop and the second suture loop comprise Nitinol.
 10. Thekit of claim 1, wherein at least one of the first suture loop and thesecond suture loop is a closed, continuous loop.
 11. The kit of claim 1,wherein at least one of the first locking member and the second lockingmember is configured to engage the bone block.
 12. The kit of claim 1,wherein the obturator is cannulated for passage over the needleguidewire.